Prognostic value of cardio-hepatic-skeletal muscle syndrome in patients with heart failure

AbstractAlthough heart failure (HF) and liver dysfunction often coexist because of complex cardiohepatic interactions, the association between liver dysfunction and physical dysfunction, and between coexistence of both and prognosis in HF patients remains unclear. We reviewed 895 patients with HF (mean age, 69.4 ± 14.2 years) who underwent liver function test using model for end-stage liver disease excluding international normalized ratio (MELD-XI) score and physical function test (grip strength, leg strength, gait speed, and 6-min walking distance [6MWD]). In the multiple regression analysis, MELD-XI score was independently associated with lower grip strength, leg strength, gait speed, and 6MWD (all P < 0.001). One hundred thirty deaths occurred over a median follow-up period of 1.67 years (interquartile range: 0.62–3.04). For all-cause mortality, patients with high MELD-XI scores and reduced physical functions were found to have a significantly higher mortality risk even after adjusting for several covariates (grip strength, hazard ratio [HR]: 3.80, P < 0.001; leg strength, HR: 4.65, P < 0.001; gait speed, HR: 2.49, P = 0.001, and 6MWD, HR: 5.48, P < 0.001). Liver dysfunction was correlated with reduced physical function. Moreover, the coexistence of lower physical function and liver dysfunction considerably affected prognosis in patients with HF.

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Associations of severity of liver damages with physical function and prognosis in patients with heart failure

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.034 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

T Noda ◽

K Kamiya ◽

N Hamazaki ◽

K Nozaki ◽

T Ichikawa ◽

...

Keyword(s):

Heart Failure ◽

Physical Function ◽

Grip Strength ◽

Liver Dysfunction ◽

Gait Speed ◽

Clinical Model ◽

Leg Strength ◽

Strength Change ◽

Function Test ◽

Physical Dysfunction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Heart failure (HF) and liver dysfunction often coexist because of complex cardiohepatic interactions, which adversely affects prognosis. However, the association between liver dysfunction and physical dysfunction, and between coexistence of both and prognosis in HF patients remains unclear. Purpose We evaluated the associations of severity of liver damage and physical function and prognosis in patients with HF. Methods The study population consisted of 895 patients with HF (mean age, 69.4 ± 14.2 years) who underwent liver function test using model for end-stage liver disease excluding international normalized ratio (MELD-XI) score and physical function test (grip strength, leg strength, gait speed, and 6-minute walking distance [6MWD]). The associations between MELD-XI score and physical function were assessed by multivariate linear regression model analysis. Moreover, we investigated the prognostic value of coexistence of liver dysfunction and physical dysfunction. The endpoint was all-cause mortality. Results After adjusting for covariates, MELD-XI score was independently associated with lower grip strength, leg strength, gait speed, and 6MWD (P < 0.001). In addition, hierarchical multivariate linear regression analysis revealed that adding MELD-XI scores or BNP explained additional variance in the physical function measures. The MELD-XI score added to the clinical model was significantly more predictive of physical function (grip strength, change in F: 27.105, P < 0.001; leg strength, change in F: 33.980, P < 0.001; gait speed, change in F: 22.826, P < 0.001; 6MWD, change in F: 59.193, P < 0.001) than BNP added to the clinical model. Eighty-six deaths occurred over a median follow-up period of 1.67 years (interquartile range: 0.62 – 3.04). Patients with high MELD-XI score and reduced physical function were found to have significantly higher mortality risk even after adjusting for several covariates (grip strength, hazard ratio [HR] = 3.80 [95% confidence interval (CI) = 2.04 – 7.08], P < 0.001; leg strength, HR = 4.65 [95% CI = 2.47 - 8.75], P < 0.001 and gait speed, HR = 2.49 [95% CI = 1.43 - 4.33], P = 0.001; 6MWD, HR = 5.48 [95% CI = 2.88 - 10.41], P < 0.001). Conclusions Liver dysfunction was correlated with reduced physical function. Moreover, the coexistence of lower physical function and liver dysfunction considerably affected prognosis in patients with HF. Abstract Figure. Kaplan–Meier survival curves

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MO554THE EFFECT OF HEMOGLOBIN CHANGES AND THE SEVERITY OF CHRONIC KIDNEY DISEASE IN PHYSICAL FUNCTION IN ELDERLY PATIENTS WITH HEART FAILURE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab085.0017 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Takumi Noda ◽

Kentaro Kamiya ◽

Nobuaki Hamazaki ◽

Kohei Nozaki ◽

Takafumi Ichikawa ◽

...

Keyword(s):

Heart Failure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Elderly Patients ◽

Physical Function ◽

Gait Speed ◽

Walking Distance ◽

Leg Strength ◽

Patients With Heart Failure ◽

The Relationship

Abstract Background and Aims Anemia is frequently observed in patients with heart failure (HF) and causes increased hospitalization and mortality rates. Anemia is also associated with and is a major risk factor of impaired physical function and frailty. On the other hand, a high percentage of elderly patients with HF have chronic kidney disease (CKD), which is an aggravating factor for anemia, and the combination of anemia and CKD has been reported to increase physical dysfunction and mortality. However, the relationship between hemoglobin (Hb) changes and physical function during hospitalization in elderly patients with HF is unclear, and the impact of CKD severity on these relationships is also unclear. This study aimed to examine the relationship between Hb changes and physical function during hospitalization in elderly patients with HF. We further examined the relationship when stratified by CKD severity. Method Seven hundred and thirty-seven elderly patients with HF, who underwent changes in Hb and physical function test (leg strength, gait speed, and 6-min walking distance [6MWD]), were included in this study. Using a multiple linear regression model, associations between Hb changes and physical function were assessed. In addition, using a generalized linear mixed model, we divided the HF patients into three groups with eGFR ≥60, 30–60, and <30, and examined whether the severity of CKD was related to the Hb change and physical function. Results The median age of the subjects in this study was 77 years (interquartile range 72–82). Changes in Hb during hospitalization were independent determinants of physical function (leg strength, β: 0.158, P < 0.001; gait speed, β: 0.023, P < 0.001; 6MWD, β: 13.039, P < 0.001), even after accounting for factors related to severity of HF. Moreover, the group with more severe CKD showed significantly lower physical function, although Hb improved (P < 0.001) with respect to leg strength and 6MWD compared with the group with lower CKD stage. Conclusion Hb change during hospitalization was an independent determinant of physical function in patients with HF. Patients with a more severe CKD showed lower leg strength values and 6MWD even if Hb improved.

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Comparison of difficulty with activities of daily living in elderly adults undergoing hemodialysis and community-dwelling individuals: a cross-sectional study

Renal Replacement Therapy ◽

10.1186/s41100-019-0250-7 ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Toshiki Kutsuna ◽

Yusuke Isobe ◽

Takaaki Watanabe ◽

Yusuke Matsunaga ◽

Satomi Kusaka ◽

...

Keyword(s):

Physical Function ◽

Grip Strength ◽

Gait Speed ◽

Community Dwelling ◽

Test Time ◽

Control Group ◽

Elderly Adults ◽

Sit To Stand ◽

Difficulty Score ◽

Usual Gait Speed

Abstract Background Elderly adults undergoing hemodialysis (HD) have multiple comorbidities, physical frailty, and functional dependence with activities of daily living (ADL). ADL difficulty is an early predictor of ADL dependency in community-dwelling elderly adults. However, the characteristics of ADL difficulty in patients undergoing HD have not yet been reported. The present study aimed to examine the current status and characteristics of physical function and ADL difficulty in ambulatory elderly patients undergoing HD. Methods In all, 136 elderly outpatients undergoing HD and 40 community-dwelling controls participated in the present study. The characteristics, physical function (SARC-F score, grip strength, five-times sit-to-stand test time, usual gait speed, maximum gait speed, and short physical performance battery score), and scores from the ADL difficulty questionnaires [difficulty related to upper limb (U/L) and lower limb (L/L) functions] were compared between the HD and control groups. Multiple regression analysis was performed to examine whether the characteristics of physical function were able to discriminate ADL difficulty in the HD group. Results The HD group had a significantly greater SARC-F score, lower grip strength, longer five-times sit-to-stand test time, slower usual gait speed, slower maximum gait speed, lower short physical performance battery score, and lower U/L and L/L ADL difficulty scores compared to the control group (all P < 0.001). The distribution of U/L and L/L ADL difficulty scores showed a wider variation in the HD group than in the control group. The U/L ADL difficulty score was independently associated with the SARC-F score (β = −0.52, P < 0.001) and grip strength (β = 0.21, P = 0.02). The L/L ADL difficulty score was independently associated with the SARC-F score (β = −0.56, P < 0.001) and usual gait speed (β = 0.35, P < 0.001). Conclusions The elderly HD group had a poorer physical function and experienced stronger ADL difficulty than the control group. There was an association between ADL difficulty and sarcopenia or poor physical function among patients undergoing HD. These findings provide useful data for effective clinical management to prevent decline of ADL in ambulatory elderly patients undergoing HD.

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Sarcopenia in older black South African women and relationships with physical activity and protein intake

Proceedings of The Nutrition Society ◽

10.1017/s0029665120000981 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Amy E. Mendham ◽

Naomi E. Brooks ◽

Lisa K. Micklesfield ◽

Mieke Faber ◽

Dirk L. Christensen ◽

...

Keyword(s):

Physical Activity ◽

Physical Function ◽

Grip Strength ◽

Muscle Mass ◽

Gait Speed ◽

Protein Intake ◽

Whole Body ◽

Ageing Population ◽

Hs Crp ◽

High Cadence

AbstractIntroductionSouth Africa (SA) is a developing country with an ageing population. Adequate nutrition and physical activity (PA) protect against the loss of muscle mass and physical function, both of which are important components of sarcopenia. This study aimed to measure the prevalence of sarcopenia in older black SA women and investigate its associations with PA and protein intake.Materials and MethodsOlder black SA women (age, 68 (range; 60–85 years) n = 122) completed sociodemographic questionnaires, 24 h urine collection (estimate protein intake), venous blood (hs-C-reactive protein (hs-CRP) and ferritin), functional tests (grip strength, 3 m timed-up-and-go (TUG), 10 m walk test) and PA monitoring (activPAL). Dual-energy x-ray absorptiometry whole-body scans assessed fat and fat-free soft tissue mass (FFSTM).ResultsAccording to the European Working group on Sarcopenia in Older People (EWGSOP)2, 2.5% (n = 3) had confirmed sarcopenia of a low severity based on normal physical function. Of the total cohort, 9% (n = 11) had low grip strength, 22.1% (n = 27) had a low appendicular skeletal muscle index (ASMI), and no women had low TUG (s) or gait speed (m/s). Higher ASMI was associated with lower hs-CRP (p = 0.05; Rho = -0.209) and higher ferritin (Rho = 0.252; p = 0.019), grip strength (kg, Rho = 0.223; p = 0.015), and gait speed (m/s, Rho = 0.180; p = 0.050). Protein intake suggested intake of 41.8g/day/ or 0.51 g/kg of body mass/day. Higher total protein intake (g/24h), was associated with higher FFSTM (kg) and ASMI (p < 0.001). PA outcomes were not correlated with FFSTM or ASMI (p > 0.05), however, there was a strong positive correlation of TUG (s) and gait speed (m/s) with time spent: 1) stepping per day (min) and; 2) at a high cadence (> 100 steps/min) (all p < 0.01). Daily step count was 7137 ± 3233 (mean ± Standard deviation), with 97.9 ± 38.7 min of total time spent stepping and 12.6 ± 16.8 min spent stepping at a high cadence (> 100 steps/min). Of note, 13.9% (n = 17) of women were completing > 10,000 steps/day.DiscussionBased on the EWGSOP2 criteria, there is a low prevalence of sarcopenia in older black SA women, explained by the maintenance of strength and physical function that directly related to PA, especially that performed at higher intensities. In contrast, low muscle mass was relatively prevalent (22.1%) and was associated with low dietary protein and not PA. Notably, it may be important to review the cut-points of EWGSOP2 criteria to be specific to the older SA women from disadvantaged communities.

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Liver Dysfunction Assessed by Model for End-Stage Liver Disease Excluding INR (MELD-XI) Scoring System Predicts Adverse Prognosis in Heart Failure

PLoS ONE ◽

10.1371/journal.pone.0100618 ◽

2014 ◽

Vol 9 (6) ◽

pp. e100618 ◽

Cited By ~ 35

Author(s):

Satoshi Abe ◽

Akiomi Yoshihisa ◽

Mai Takiguchi ◽

Takeshi Shimizu ◽

Yuichi Nakamura ◽

...

Keyword(s):

Heart Failure ◽

Liver Disease ◽

Liver Dysfunction ◽

Scoring System ◽

End Stage Liver Disease ◽

End Stage

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Pulmonary and Physical Function Limitations in Aging Men with and without HIV from the Multicenter AIDS Cohort Study

Innovation in Aging ◽

10.1093/geroni/igab046.2328 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 612-612

Author(s):

Mona Abdo ◽

Ken Kunisaki ◽

Valentina Stosor ◽

Gypsyamber D'Souza ◽

Madiha Abdel-Maksoud ◽

...

Keyword(s):

Cohort Study ◽

Pulmonary Function ◽

Physical Function ◽

Grip Strength ◽

Gait Speed ◽

Pulmonary Function Tests ◽

Forced Expiratory Volume ◽

Multicenter Aids Cohort Study ◽

Aging Men ◽

Hiv Serostatus

Abstract We sought to determine effects of age, HIV serostatus, and smoking on the associations between pulmonary function and physical function impairments using Multicenter AIDS Cohort Study data. Associations between physical function outcomes gait speed (m/sec) and grip strength (kg) with normalized pulmonary function tests (diffusion capacity for carbon monoxide (DLCO, n=1,048) and forced expiratory volume in one second (FEV1, n=1,029)) were examined. Adjusted mixed-effects models included interaction terms to assess effect modification. 574(55%) were HIV+, with median age 57(IQR=48,64) and mean cumulative smoking pack-years 12.2(SD=19.0). 349(33%) had impaired DLCO (<80% of predicted) and 130(13%) had impaired FEV1 (<80% of predicted). Participants with impaired DLCO had weaker grip strength than those with normal DLCO (estimate= -3.5[95% CI=-4.6,-2.4]kg; p<0.001). Participants with impaired DLCO had slower gait speed than those with normal DLCO (estimate= -0.04[95% CI= -0.06,-0.02]m/sec; p=0.002). Age modified the DLCO effect on gait (p-interaction=0.01) but not grip (p-interaction=0.09). The association between decreased DLCO and slower gait was more pronounced in older participants. Smoking or HIV serostatus did not significantly modify the DLCO effect on gait (all p-interaction≥0.14) or grip (p-interaction=0.74, p-interaction=0.058, respectively). As with DLCO, participants with impaired FEV1 had weaker grip strength (estimate=-3.0[95% CI= -4.7,-1.3]kg; p<0.001) than those with normal FEV1. FEV1 was not associated with gait speed(p=0.98). Age, HIV serostatus or smoking did not modify the associations between FEV1 and gait speed or grip strength (all p-interaction>0.05). Associations between lower DLCO/FEV1 and decreased physical function suggest that interventions to improve pulmonary function may also preserve physical function with aging.

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Prognostic Value of the Modified Model for End-Stage Liver Disease (MELD) Score Including albumin in acute heart failure

10.21203/rs.3.rs-120667/v1 ◽

2020 ◽

Author(s):

Shengen Liao ◽

Xinyi Lu ◽

Iokfai Cheang ◽

Xu Zhu ◽

Ting Yin ◽

...

Keyword(s):

Heart Failure ◽

Liver Disease ◽

Acute Heart Failure ◽

Prognostic Value ◽

Cox Regression ◽

International Normalized Ratio ◽

Meld Score ◽

End Stage Liver Disease ◽

All Cause Mortality ◽

End Stage

Abstract Background: Liver and renal function evaluated by the model for end-stage liver disease (MELD) score, the MELD excluding the international normalized ratio (MELD_XI) score and the MELD including sodium (MELD_sodium) score have been considered predictors of adverse events for patients with acute heart failure (AHF). However, the prognostic value of the MELD including albumin (MELD_albumin) score in patients with AHF has not been assessed. Methods: A total of 466 patients with AHF were prospectively evaluated. We compared the accuracy of the 4 MELD score formulas using the time-dependent receiver operating characteristic (ROC) curve and corresponding areas under the curve (AUC). Results: During a median follow-up period of 34 months, 196 deaths occurred. In the fully adjusted Cox regression model, standardized hazard ratios with 95% confidence interval expressing the risk of all-cause mortality were 1.22 (1.06–1.40), 1.20 (1.04–1.39), 1.21 (1.05-1.41) and 1.23 (1.06–1.42) for MELD, MELD_XI, MELD_albumin and MELD_sodium scores, respectively. The MELD_albumin score showed the best prognostic accuracy (AUC = 0.658) for the prediction of long-term all-cause mortality, followed by the MELD_sodium score (AUC = 0.590), the MELD score (AUC = 0.580), and the MELD_XI score (AUC = 0.544). Conclusions: The MELD_albumin score performs more accurately than the MELD score and the other modified MELD scores for predicting the risk of all-cause mortality in patients with acute heart failure.

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Trajectories of Objectively Measured Physical Function Among Older Breast Cancer Survivors in Comparison With Cancer-Free Controls

10.21203/rs.3.rs-768755/v1 ◽

2021 ◽

Author(s):

Juhua Luo ◽

Stephen J. Carter ◽

Elizabeth M Cespedes Feliciano ◽

Michael Hendryx

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Physical Function ◽

Grip Strength ◽

Cancer Diagnosis ◽

Gait Speed ◽

Breast Cancer Survivors ◽

Breast Cancer Diagnosis ◽

Quadriceps Strength ◽

Over Time

Abstract PURPOSE: Aging associated with progressive declines in physical function is well-known; however, little is known about the trajectories of physical function before and after breast cancer diagnosis. The current study examined the trajectories in objective measures of physical function over 20 years for women with breast cancer and matched controls. METHODS: 2712 community-dwelling women (452 breast cancer cases and 1:5 matched cancer-free controls) aged 65 years or older at baseline (1986-1988) within the Study of Osteoporotic Fractures were followed for 20 years. Objective physical function was assessed up to 9 times, including hand-grip strength, timed chair stand, gait speed and quadriceps strength. Linear mixed models were used to model physical function changes in terms of secular time trend, group (cases or controls), period (pre-and post-diagnosis status), and their interaction terms. RESULTS: We observed all measures of physical function declined over time. While no differences in trends between cases and controls during the pre-diagnosis period were observed, after cancer diagnosis, grip strength and gait speed declined significantly faster in cases than controls. Quadriceps strength significantly decreased ~7 pounds shortly after breast cancer diagnosis, and then improved over time. CONCLUSION: Our prospective study revealed that older breast cancer survivors had significantly worse declines in grip strength and gait speed and a sharp, short-term drop followed by gradual improvement over time in quadriceps strength, compared to women without cancer. These findings suggest exercise training targeting muscle strength and mobility would be beneficial among older breast cancer survivors.

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B-type natriuretic peptide (BNP) predicts 90-day mortality and need for paracentesis in cirrhotic patients without systolic heart failure

Scientific Reports ◽

10.1038/s41598-020-78946-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tiago Araujo ◽

Ishaan Vohra ◽

Pedro Palacios ◽

Vatsala Katiyar ◽

Estefania Flores ◽

...

Keyword(s):

Heart Failure ◽

Liver Disease ◽

Natriuretic Peptide ◽

Systolic Heart Failure ◽

Serum Levels ◽

International Normalized Ratio ◽

Underlying Disease ◽

Secondary Outcome ◽

Urban Hospital ◽

End Stage

AbstractFluid overload is a common complication in patients with cirrhosis. B-type natriuretic peptide (BNP) is a marker of increased blood volume, commonly used in heart failure, that has been shown to be elevated in patients with liver disease. This study examined if BNP levels can be used to determine prognosis and predict worsening of ascites in patients with cirrhosis without concomitant heart disease. A retrospective study was performed at a large urban hospital in Chicago, Illinois and included 430 patients with cirrhosis who had BNP levels ordered during their hospital stay. Patients with clinical heart failure, arrhythmias or pulmonary hypertension were excluded. The primary outcome was 90-day mortality and the secondary outcome was a requirement for therapeutic paracentesis in the 90 days following BNP results. 53 patients (12%) had BNP levels ≥ 300 pg/mL. They had significantly increased serum levels of creatinine, bilirubin, and International Normalized Ratio (INR) when compared to those with BNP < 300 pg/mL. Patients with higher BNP had significantly higher mortality rates (HR 3.49; p = 0.037) and were more likely to require therapeutic paracentesis (HR 2.26; p = 0.02) in the next 90 days. A BNP ≥ 300 pg/mL had specificity of 88.2% in predicting 90-day mortality. BNP may serve as a practical and reliable marker of underlying disease severity in patients with cirrhosis, with potential to be included in prognostication tools for assessment of end-stage liver disease.

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Sarcopenic Obesity Indices Are Major Determinants of Bone Strength in Older Adults With Obesity

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.486 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A239-A239

Author(s):

Giulia Gregori ◽

Arjun Paudyal ◽

Yann Barnouin ◽

Alessandra Celli ◽

Reina Condevillamar Villareal ◽

...

Keyword(s):

Older Adults ◽

Physical Function ◽

Grip Strength ◽

Bone Strength ◽

Distal Radius ◽

Bone Quality ◽

Gait Speed ◽

Failure Load ◽

Knee Extension ◽

Knee Extension Strength

Abstract Background: The increasing number of older adults with obesity is a growing public health problem because of increased risk of fractures especially at the ankle and upper leg despite normal or high bone mineral density. Among the contributory factors for fracture risk in this population may be aging- and obesity- associated physical frailty and impaired bone quality. However, how the adverse changes in physical function and body composition in this aging and obese population contribute to bone quality as assessed by finite element analyses (FEA) of bone strength has not been determined. Methods: One-hundred sixty-nine older (age ≥ 65 yrs.) adults with obesity (BMI ≥ 30 kg/m2) were recruited to participate in lifestyle intervention trials at our Medical Center. All underwent baseline measurements of bone strength (failure load [N] and stiffness [N.mm-1]) as estimated using FEA from high-resolution peripheral quantitative tomography (HR-pQCT) of the distal radius and tibia. In addition, body composition (appendicular lean mass/BMI [ALMBMI], fat mass/height2 [FMI]) was assessed by dual-energy x-ray absorptiometry (DXA) and physical function by the modified physical performance test (PPT), knee extension strength (isokinetic dynamometry), hand grip strength, and 4-meter gait speed. Results: Bivariate analyses showed that ALMBMI (r=.57 to .58), FMI (r=-.16 to -.17), gait speed (r=.20 to .21), grip strength (.56 to .57), and knee extension strength (r=.40 to .42) correlated with stiffness and failure load at the distal radius (all P<0.05). In addition, ALMBMI (r=.65 to .67), FMI (r=-.22 to .23), gait speed (r+.18 to .19), grip strength (r=.58 to .59), and knee extension strength (r=.44 to .45) correlated with stiffness and failure load at the distal tibia (all P<0.05). Controlling for age and sex, multiple regression analyses revealed that ALMBMI (β=.34 to .35) and grip strength (β=.28 to .29) were the independent predictors of stiffness and failure load at the distal radius, explaining 45% to 46% of the variance in stiffness and failure load (P<0.001). On the other hand, multiple regression analyses revealed that ALMBMI (β=.45 to .52), grip strength (β=.27 to .28), and FMI (β=.17 to .18) were the independent predictors of stiffness and failure load at the distal tibia, explaining 74% to 75% of the variance in stiffness and failure load (P<0.001). Conclusions: These findings suggest the importance of preserving muscle mass while reducing fat mass and improving physical function to maintain bone quality and decrease the risk of fractures when older adults with obesity undergo lifestyle intervention.

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